What Must We Do To Meet Healthy People Goals? 

By Clay E. Simpson, Jr., MSPH, PhD


Deputy Assistant Secretary for Minority Health


Office of Minority Health, U.S. Department of Health and Human Services


Closing the Gap, Healthy People 2010 and Beyond • August/September 1998


The Healthy People 2000 progress reviews, Health United States 

1998, and other data developed by HHS, provide a mixed 

picture of our success in reducing health disparities among all 

Americans. 

Success Stories 

For more than half of the objectives (56 percent), we’ve seen an 

improvement. We are making progress for 43 percent of the objectives, and we are reaching or surpassing our targets for 13 percent. We 

have closed the gap between Black and White women in the use of 

mammograms. Health United States 1998 reports that Black women 

are as likely or more likely than White women to report having a recent 

mammogram. 

The proportion of Hispanic women age 18 and over that have 

ever received a pap test has increased from 75 percent in 1987 to 91 

percent in 1994—approaching the year 2000 target of 95 percent, 

according to Healthy People Review 1997. 

Teen birth rates for minorities are on the decline. The rates for 

15-19 year old Black teens dropped 21 percent between 1991 and 

1996 to their lowest level ever. Teen birth rates declined 9-13 percent 

during this period for Whites, American Indians, Asian and Pacific 

Islanders, and Hispanics. 

We are closing some of the gaps in chronic liver disease and 

cirrhosis. In 1980, Blacks were 96 percent more likely to die from 

chronic liver disease and cirrhosis than whites. In 1995, Blacks were 

only 30 percent more likely to die from chronic liver disease and 

cirrhosis than whites. Heart disease mortality has declined for all racial 

and ethnic groups since 1985, and the largest decline in heart failure 

deaths among the persons aged 65 and older between 1988 and 

1995 was among Black men. 

Yet we are far from reaching many of our year 2000 objectives. 

For 18 percent of the objectives, we actually moved away from 2000 

targets; for 2 percent we were stagnant; and for 7 percent we experienced mixed results. We have insufficient data to assess progress for 

another 14 percent of the objectives. The situation is even more 

severe for our minority-specific objectives. Here are some examples: 

For American Indians and Alaska Natives (AI/AN), nine objectives showed movement away from the targets, including overweight 

prevalence, diabetes prevalence, and cirrhosis deaths, according to the 

1995 Progress Review for AI/ANs. 

In 1994, the homicide rate among Hispanic males aged 15-34 

increased to 52.2 per 100,000 from the 1987 baseline of 41.3 per 

100,000. The year 2000 target is 33 per 100,000. 

Tuberculosis incidence rates among Asian Americans and Pacific 

Islanders (AAPI) are approximately five times higher than the rates for 

the total population. And, the tuberculosis rate for AAPIs is increasing while decreasing for the total population. 

The Challenges 

Many strategies must be pursued. Nearly 50 percent of all AIDS 

cases have been reported among racial and ethnic minority communities, while minorities make up only 25 percent of the total population. 

Prevention and behavior change, if coupled with improvements in 

research, service availability, and therapeutic interventions, can make a 

major difference in reducing the HIV burden on minority communities. 

Cultural competence is critical. Services must be accessible and 

acceptable to all Americans, regardless of their racial or ethnic background, language, education level or financial situation. Some groups 

see a stigma attached to seeking care for a problem such as a mental 

health condition. Getting them through the door of the health system is itself a challenge. For others, the health system they meet is an 

unfamiliar and unfriendly one, unresponsive to their needs, denigrating their dignity, and uncomprehending of their understanding of 

health and disease. These factors cannot be ignored by providers and 

public health workers who seek to be effective. 

Research is another critical area, but the concept of research can 

be intimidating to some communities. The legacy of the Tuskegee 

Syphilis Study is not positive, and suspicion of researchers’ hidden 

agendas presents unique challenges to the participation of minority 

communities in the research process. 

For still other objectives, the differential impact of environmental hazards on minority communities must be confronted if high rates 

of disease are to be eliminated. And finally, health outcomes will be 

difficult to change without sustained attention to poverty, lack of 

education, and racism, all of which correlate strongly with poor health 

status. 

Public involvement in Healthy People 2010 is essential to ensure 

that elimination of health disparities is placed at the center of the 

agenda, to ensure that appropriate targets are set, and to implement 

and support creative public health strategies. We can begin by learning from the Healthy People 2000 experience and by setting ambitious objectives that will guide us on the right path for the next 

decade.

Office of Minority Health Resource Center U.S. Department of Health and Human Services